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• <br /> rala' EVERETT PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 3430 16TH ST Permit#: PW1909-076 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: REMOVE, REPLACE 1900 SQ FT CONCRETE SLAB,ADD CURTAIN WALL <br /> PW Reviewer to select all that apply below: <br /> Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation&Cost Est.) <br /> ❑ New Connection to main plus connections to building ❑ New Connection, Size -0 Per Cost Estimate <br /> ❑Alteration ❑ Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair ❑Water System Development Fee Total: $ <br /> ❑ Cap-off, quantity ❑Sewer System Development Fee Total: $ <br /> ❑ Reconnection to stub 0 Water Service Line(behind meter), Size <br /> 4.1 Backwater Valve ❑ Backflow Prevention (Outside Building): ❑ RPBA or❑ DCVA <br /> tfliNOT REQUIRED KNOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size ❑ New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size ❑3A" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total:$ 0 Backflow Prevention(Outside Building): ❑ DCDA <br /> ❑ Backflow Prevention (Outside Building): ❑ DCVA IOT REQUIRED <br /> ❑ NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑Yes, Quantity , See attached for reference. <br /> In61OT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Prevention (Inside Building): 0 DCVA (for Domestic service) ❑ RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> 44NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> I EYES, Stormwater Total: $ �2 Jr"5 ❑YES,Traffic Mitigation Total: $ <br /> ❑ Roof Only Fee on Bldg Permit(ground hard surfaces fee on PW Permit) ❑ See Attached for calculations/credit <br /> I$�All Hard Surface Fees to be added to Permit# pGJ/'i t) " 19 &MOT REQUIRED <br /> ❑ NOSee Attached Spreadsheet for calculations/credit <br /> T REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> ❑YES—TYPE: ❑ SFR ❑ DUPLEX ❑ADU ❑ INFILL DWELLING ❑ MULTI-FAMILY 0 COMMERCIAL <br /> ❑ See Attached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> ❑ Digital copy attached to permit record, Permit# <br /> 0 Saved to Address Folder in Development Tech File <br /> 14iOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑YES—Type <br /> NOT REQUIRED <br /> eason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> "1?1 YES, Permit#PW l q"9" u'7 <br /> OStormwater NPDES b C leted in TRAKiT 0 ADA Tab Completed in TRAKiT IOdnspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: AO/ ®y/ <br /> /417 <br /> Worksheet Checked By: Date: /// <br /> REVISED 4/24/2019 <br />